---

SPOTLIGHT
Karen Timmons

Karen Timmons, president and CEO of Joint Commission International.

 Publisher Laura Carabello recently had the opportunity to speak with Karen Timmons, president and CEO of Joint Commission International. JCI is part of The Joint Commission, the leading accreditation organization for US hospitals. International hospitals seek accreditation to demonstrate quality, and JCI accreditation is considered a seal of approval by medical travelers from the US and patients and caregivers around the globe.

JCI has also been designated a Collaborating Centre for Patient Safety Solutions by the World Health Organization and is developing an international collaborative network to improve patient safety. Ms. Timmons is a past board member and Treasurer for the International Society for Quality in Healthcare (ISQua).

What follows is part one of a two-part series featuring highlights of their conversation.

Laura Carabello (MTT):During the recent Consumer Health World meeting in Washington, DC, a representative from one of the foreign hospitals said that JCI accreditation is another example of US imperialism. How would you respond?

Karen Timmons (KT): I don’t agree with that statement. We actually like to think of ourselves as an international company, headquartered in the United States.

MTT: With the growth of medical tourism, has the JCI mission changed in any way?  

KT: No, our mission has been and continues to be focused on improvement and helping organizations improve the quality and safety of the care they provide to the public. We were established in the early 1990s and started doing international work. Around 1994, our footprint expanded because many ministries of health and other key stakeholder groups that had been going to our parent company, The Joint Commission, needed assistance in developing their own national accrediting bodies or national standards to assess the quality of care within their countries or regions.

In 1999, the Joint Commission hosted 30 study tours for different countries. Literally, 30 weeks out of 52 were spent on international projects and the interest was intense. It was determined that it would be most appropriate to place those activities in the not-for-profit affiliate, then known as Quality Healthcare Resources (QHR). At that time, QHR provided technical assistance and education primarily to key stakeholders and ministries of health, helping them to establish their own national accrediting bodies or standards.

A keen interest in quality and safety evolved over the next four years, and the question of providing accreditation was presented to the Joint Commission or, more specifically, Joint Commission International (JCI). At that time, it was determined that the use of domestic standards internationally would be inappropriate, and if there was going to be the attestation of international accreditation, it should be founded upon an international set of standards that would be applicable to various countries, with their unique healthcare and delivery systems. It would need to be more sensitive to various cultural differences.

We called together a panel of about 18 different experts from around the globe, ensuring international representation from the five major regions of the world, and developed the first set of standards.

Certainly, this group of experts used the framework that had been established in the domestic standards, but they really delineated any references to the national or federal agencies or things that would not be applicable internationally. There is a lot of jargon, as you can imagine, in the United States, but things such as an organized medical staff would not be applicable, as not every country has an organized medical staff.

The area such as patient consent, for example, is not always uniform. Here in the United States the individual patient would sign a consent form; that’s not always the case in other countries. Different countries might have different cultures where the family might be the more appropriate body to sign consent. We developed our standards with those sensitivities in mind and, of course, the mission to help improve quality and safety has always been there.

As I said in the beginning, we view ourselves as an international company. I say that because we’re not interested in just exporting the American model. We have international representation on our Board. In fact, it’s a requirement in our by-laws that three board members be international members. Our standards committee is composed entirely of international experts. We also have regional advisory councils, specifically Europe, Asia-Pacific, and the Middle East. We really try to insure that we’re listening to the needs, that we understand the differences of different healthcare systems, and that we learn from them.

MTT:You actually answered my second question: are the standards different for accrediting domestic versus international hospitals? Obviously they are.  

KT: I would say that the standards are comparable to the Joint Commission’s domestic accreditation standards. However, after we cross-referenced the standards, we recognized that they are clearly different and have been adapted for the international community. They are designed to be applicable to various cultures and healthcare delivery systems.

MTT:Do you believe the cost of accreditation is hampering foreign hospitals from achieving JCI accreditation? Is there any flexibility in pricing?

KT: Certainly, we do not believe that the cost of accreditation is hampering any major acceleration in the number of organizations seeking accreditation. I think part of that obviously has to do with the environment that you mentioned when we first started speaking.

The average cost of accreditation is about $30,000, but that covers a three-year period. Obviously, that breaks down to $10,000 per year.

MTT:I dislike the word cheap—but that’s cheap.  

KT: Yes. And in many organizations, as you know, it really is a commitment to quality. But you have to pay for quality. To simplify it, you pay extra for cars that have the air bags on the side so…you pay for this, too.

MTT: So if you had one additional patient a year because of the accreditation, it would pay for itself. Do you agree?

KT: Well, I quoted you the average cost. But you also asked about flexibility. The fees are really based on a number of factors, including the complexity of the services offered by an organization, the number of beds and things of that nature.

MTT:How many hospitals are currently accredited? Pending?

KT: There are about 150 hospitals that are accredited right now. We have another 105 surveys this year, of which about 47 will be triennial (or re-accreditation) surveys. I would say that by the end of the year, we probably will have a little over 200 accredited.

MTT: I think there is confusion in the marketplace about the various accrediting bodies.

KT: I agree. For example, the International Society for Quality in Healthcare (ISQua) is always cited. Actually, hospitals are not ISQua-accredited. ISQua accredits accrediting bodies, and JCI is ISQua-accredited.

In fact, we are a founding member of ISQua. I serve on the Board and I also serve on the Alpha Council, so we are very strong supporters of ISQua.

MTT: It’s interesting, because when you ask these hospitals if they are JCI accredited, they say ‘Oh no, we’re not, but we meet the ISQua standards. They use that answer to convince Americans that it is some kind of accrediting body. Can you explain how ISQua operates?

KT: Sure, but first I want to make the point that I think patients and consumers should be looking for accreditation by entities that have been accredited by ISQua. You will not find a healthcare organization accredited by ISQua, only accrediting bodies.

ISQua develops the standards and principles that should guide an accrediting body on how to conduct itself. So it really is ‘walking the talk’ for accrediting bodies like ourselves. It requires us to put ourselves under the same scrutiny, to have the same quality improvement philosophy, and be sure that we’re listening to key stakeholder groups -- just as we advise healthcare organizations to make sure that they’re listening to their key customers, patients and staff.

MTT: Besides yourself, what other accreditation bodies are accredited by ISQua?

KT: There’s the Australia Council, Canadian Council, the French national accrediting body called HAUTE Authority.

MTT: Let’s take a moment to look at this from the consumer perspective. If a hospital is accredited by the Australian Council, for example, how should the American public feel about that? Should they accept that? Or should they be looking for JCI?

KT: They should be looking for Joint Commission International Accreditation because we are the premiere accrediting body and we have the highest level of standards worldwide. We are also the only accrediting body that has developed international standards. The other entities that are providing services internationally are using their own national standards.

MTT: So, Australia and Canada would be using only their national standards.

KT: Correct. We also have compared our standards to the Joint Commission’s standards. We use the leading-edge survey methodology such as the tracer methodology.

MTT:What is the tracer methodology?

KT: We trace the path of a patient’s journey through a hospital to ensure compliance with the standards. When doing our site visit, we would, based upon the volume of services within that organization, actually ask to see a patient’s record.

We’d be looking to see that the organization has filled out on their application the type of services that are provided. Suppose someone came in having a heart attack and ended up in post-surgical care: We might trace that patient back to the emergency room and as they went through the various services or procedures that they’ve received, we would insure compliance with our standards.

We would be talking to the staff that had been taking care of that patient—how did they get consent? We would be asking whether or not they identified the patient. We trace the journey of the patient through the care they received throughout the hospital; hence, it’s called tracer methodology. So it’s an actual patient.

Some accrediting bodies spend a lot of time looking at document reviews—they’re just looking at documents of meetings and looking to see whether or not there’s paper. We actually look at the care provided and what actually happens to patients. It’s very care-centered, very patient-centered.

MTT:Have you ever turned a hospital down? And if so, what percentage of applicants would you say don’t meet standards?

KT: Yes, we have. The number is roughly one percent. But for many organizations—especially for those that are in growth mode and first-time organizations seeking accreditation—if there is one area where they are not in compliance, we very well might ask a surveyor to go back in three months and re-evaluate them. Before we provide accreditation or give them the award of accreditation, they would have to improve their compliance.

In our next issue we will continue the conversation between our publisher, Laura Carabello, and Karen Timmons, and take a look at credentialing options, the future of medical travel, and the opportunities and challenges for American providers.

SPOTLIGHT
Kumar Jagdeesan

Kumar Jagadeesan, vice president, StarHospitals.net

In this Spotlight we speak to Kumar Jagadeesan, vice president of Star Hospitals.net. Launched this past January, Star Hospitals.net operates physician-staffed call centers across India designed to help potential global healthcare patients find the appropriate facilities and services needed for their given need. We spoke to Kumar about how he got involved in the industry and how things are going so far.

Medical Travel Today (MTT):Let’s begin with a discussion on how you came to start Star Hospitals.net.

Kumar Jagadeesan (KJ): I guess there are three factors that contributed to my involvement:

First, I’m originally from Chennai, India, which is really the birthplace of medical tourism. The city sees a huge number of international patients every year coming to all the Super specialty hospitals located there. Plus, I have a number of family members in the medical profession. So, while I’m not a doctor, I know a great deal about how the business works in the city.

Second, I worked for a number of years in Dubai for a major airline supporting medical tourism. So I come to this with a very strong understanding of the travel-side of the business which is integral to the overall platform.

Finally, upon moving to North America a few years ago, I began to really appreciate the difficulties surrounding access to care in North America. In the United States, you have issues with the uninsured and the skyrocketing costs of various procedures. In Canada, the health system often creates long waits to see a physician or to get a surgery.

Putting all this together, I joined up with a team of medical professionals who felt the time was right to start Star Hospitals.net.

MTT:And how exactly does Star Hospitals.net operate?

KJ: We have offices in all the major cities in India, as well as Thailand and Singapore. Our call centers, staffed with physicians and physician assistants, are truly the ones who answer the phones and help patients research their care options.

If you call up with any medical condition, you will speak with one of our physicians. After consulting and studying your medical report, our physician will review the panel of physicians at our 13 hospitals and select the doctor who is best suited to your needs. Our team will develop an initial cost estimate, allowing you to choose from three or four hospitals.

Based on your approval of this initial estimate, our physician will arrange a teleconference with a potential surgeon. We even encourage our patients to have their family doctor participate during the teleconference. These calls can really help to put everyone at ease, especially the patient.

The teleconferencing is also an option when the patient returns home. We follow up personally with the patient for at least three months to assess individual progress. If patients would like to schedule a teleconference as part of that process, we’re happy to provide it.

What endeavor to put medical needs first, not the travel. Anyone can get you anywhere --- but not everyone can match you to the right hospital, the right surgeon, and so forth. We feel this is our commitment to our clients.

MTT:You mentioned you work with 13 hospitals. How did you select which ones you would partner with?

KJ: I’m glad you asked this question. All the hospitals we work with are either JCI, ISO or NABH accredited with doctors who are American board certified and US or UK trained. We only work with those that uphold the highest standards. We also have a list of 15 or so additional hospitals that we will partner with once they get their JCI accreditation. For some of those hospitals, it’s just a matter of waiting for the paperwork. We don’t take any chances when it comes to the health of our clients.

MTT:You operate largely out of call-centers. Does that mean when the patient arrives, they don’t see anyone?

KJ: Oh no, with us it is the other way around. You will be surprised with our presence there, where it matters most. When they arrive at the destination airport, one of our representatives is there to meet with them at the arrival and will stay with them throughout the entire process of transportation to the hospital, money exchange, registration at the hospital -- every aspect of the trip until the duty doctor from the respective hospital meets with the patient. We usually dedicate a coordinator for each patient on a 24/7 basis, and this individual will be responsible for checking with the doctor and patient on all medical progress.

When someone travels alone, we offer nursing assistance at a fraction of cost that you would expect. This assistant remains with the patient 24/7 to make certain that he or she is comfortable and feeling secure.

For those who travel with a companion, we offer a “companion program” designed to elevate both the body and the mind. This option can be decided upon pre- or post travel and our coordinator will help you through the process. Many times a companion may want to do more than just stay at the bedside. We can take them shopping or sightseeing – whatever suits their interests.

Following treatment, if people choose to stay longer, our representative can get patients to their next destination, whether it is a rehabilitation center, a resort or a hotel.

We care for the patient from start to finish and beyond. I say this in bold letters…WHEN YOU ARE WITH US …YOU ARE NEVER ALONE.

MTT:Tell us a bit of about the Web-side of your operation.

KJ: Yes, we’re very excited about this. The site allows patients to learn about the various facilities we work with to ensure a complete experience. They can also enter live chats with our physicians.

We have a “password protected folder” system that allows patients to share their medical information on a completely confidential basis. So much of what happens before a procedure is about the transfer of personal medical data. On our site, they can do so without any concerns about security or risks. The folder gets updated on a daily basis and can be shared with loved ones. This process helps to overcome any anxieties.

The site really simplifies the whole transfer process and ensures that we have the most up-to-date information on a patient possible.

MTT: You mentioned earlier that you have travel background. How does that apply to the business?

KJ: We handle all the travel arrangements for patients — travel visas, airfare, hotel, transportation, etc. Patients are likely to come into contact with various services during their trip, so we think ahead for them and ensure that all goes smoothly.

We even break up flights for patients who may not want to undertake a 10,000-mile trip before surgery. In those cases, we can set up a few stay over days in Europe or Dubai, for example, just so they can get their feet under them a bit before surgery.

My background also allows me to negotiate on behalf of the patient.

MTT: Where are your patients coming from at this point and is there any pattern to the type of care they seek?

KJ: We have a lot of patients from both North America and the Middle East. The North American patients appreciate the reasonable pricing of care, especially for cardiac and orthopedic surgeries. The Middle Eastern patients really seek any treatment they can’t access in their homelands – including cardiac, orthopedic and neurosurgery. Plus, we’re seeing an up-tick in dental care and eye surgeries.

PERSPECTIVES

Consumer Health Word Conference Set to Examine and Assess Emerging Trends, Innovations and Successful Strategies to Lower Costs and Improve Consumer Health

Las Vegas, NV — March 19, 2008 — Fasten your seatbelts for one of the most productive healthcare leadership events in 2008: Consumer Health World Conferences (www.consumerhealthworld.com), May 4-7, 2008, Las Vegas, NV, The Venetian Resort Hotel sets the stage for all stakeholders to identify and assess integrated solutions for improving healthcare and lowering costs.

Join thousands of employers, benefits payers, financial services, healthcare providers, third party administrators and other stakeholders from every corner of the world who will evaluate their investment of time and resources in consumer-focused healthcare initiatives: wellness programs, disease management and prevention, medical tourism, fitness, as well as technologies and tools connecting consumers to their health.

Free media registration:
http://www.transmarx.com/corsdev/Accounts/Register.aspx

The CHW umbrella brings together three conferences, connecting stakeholders with targeted audiences, including demonstrations and presentations by leading international medical centers:

The National Conference On Health Care Consumerism (NCHCC)
http://www.nchconsumerism.com

Focus upon employer healthcare and wellness strategies -- discover innovative plan designs and funding options -- examine the impact of healthcare policy reform on employers and consumers.

The Health Care Globalization Summit
http://www.hcglobalsummit.com

Explore trends, issues and solutions in global care that are impacting medical travel, quality, continuity of care, medical information exchange technology and insurance coverage. Gain knowledge and industry perspectives of employers, health plans, U.S. providers – and consumers! An exclusive patient experience day will allow consumers access to learn about their medical travel options and interact with delegates from international medical centers.

Health 3.0 Summit
http://www.health30summit.com

What’s hot in technology? Find out what’s impacting fully wired consumers and their ubiquitous Web activities. Discover future technologies connecting patients, providers and payers, and radical visions for the health plan of the future.

“You will meet and interact with decision-makers and senior level executives who are making a difference in every aspect of healthcare delivery,” states Wendy Borow-Johnson, Consumer Health World Chair. “These combined conferences connect stakeholders who share the goal of aligning personal health with optimal organizational performance. As a result, consumers will enjoy improved access to affordable quality care and reap the benefits of a global healthcare marketplace.”

Keynote Speakers and Headliners for Consumer Health World include:

• John Agwunobi, M.D., Senior Vice President and President, Professional Services Wal-Mart Stores Division
• Clement Bezold, Ph.D., Chairman, Institute for Alternative Futures
• Bill Crounse, M.D., Worldwide Health Director, Microsoft Corporation
• David Hom, Chairman, Center for Health Value Innovation
• Wayne Sensor, Chief Executive Officer, Alegent Health
• Sally Pipes, President & Chief Executive Officer, Pacific Research Institute
• Jerry Reeves, M.D., Chief Medical Officer, Hotel Employees and Restaurant Employees International Union (H.E.R.E.I.U.) Welfare Funds
• Tara Wooldridge, LCSW, Clinician, Medical and Health Management Department, The Home Depot
• Gary Ahlquist, Senior Vice President, Booz Allen Hamilton
• Jay Savan, CEBS, CLU, ChFC, CFP, Principal, Towers Perrin
• Bill Whitmer, MBA, President and Chief Executive Officer, Health Enhancement Research Organization (HERO)
• Fred Williams, Director of Benefits and Strategic Alliances, Quest Diagnostics
• Paul Mango, Director, McKinsey and Company
• Sander Domaszewicz, Principal, Mercer Human Resource Consulting
  
  

Consumer Medical Tourism Expo and Consumer Experience Days at Consumer Health World for Las Vegas Residents and Visitors

Monday, May 5, 2008, 8:30 a.m.-4:30 p.m.; Tuesday, May 6, 2008, 10 a.m.-4 p.m. Venetian Hotel and Casino

Las Vegas, NV — March 24, 2008 — Healthcare consumers are asking questions about medical tourism along with vital questions about improving and maintaining their health. People of all ages who are interested in health, wellness and achieving optimal health are encouraged to attend the Consumer Medical Tourism Expo and Consumer Experience Days , Monday, May 5, 2008, with expo hours 11:00 a.m.-4:30 p.m. on Monday, and Tuesday, May 6, 2008, 10 a.m.-4 p.m. as part of The Consumer Health World Conferences (www.consumerhealthworld.com), Venetian Hotel and Casino, Las Vegas, NV. A special Patient Medical Tourism Workshop will be held from 8:30 to 12:00 on Monday May 5, 2008. The expo health fair, featuring select services from Canyon Ranch Spa, will also include opportunities to meet medical tourism specialists who can provide information regarding consumer options for medical care outside the United States.

Free media registration:
http://www.transmarx.com/corsdev/Accounts/Register.aspx

Admission to Consumer Medical Tourism Expo and Consumer Experience Days is $10 per person with the CONSUMER HEALTH coupon QJUHIFIHVP for discounted admission.

“Consumer Medical Tourism Expo and Consumer Experience Days at Consumer Health World present opportunities for local residents and visitors to learn more about the tools for achieving and maintaining a healthy lifestyle – as well as the vast array of options for accessing medical care outside the country at a fraction of the cost of US-based services,” states Skip Brickley, CEO of Transmarx, LLC, one of the country's premier conference and trade show producers. “The Consumer Health World Conference is an ideal venue for consumers to explore medical tourism and to understand the quality and cost-savings of these options.”

Consumer Experience Day attendees will also have access to an informational session entitled, “Introduction toGlobal Health Care: It’s More than Passports and Airplanes.” Conducted by Joe Woodman, author of the definitive medical tourism book --Patients Beyond Borders – the session will offer consumers a bird-s eye view of international medical travel and the contemporary global healthcare arena.

Phil Slaton, president and CEO of The Icon Group, producer of Medical Tourism Expos, adds, “Medical tourism is the answer for uninsured, under insured and affluent Americans looking for quality procedures with significant cost savings. By staging events such as the Las Vegas Consumer Medical Tourism Expo and Consumer Experience Days at Consumer Health World, the consumer will be provided an invaluable venue for better understanding of this cost effective option for their medical care.”  

Hospitals Worldwide Turn to Unotron’s GermStopper ™ :

Next Generation SpillSeal ® Washable Keyboards Upgraded with Anti-Bacterial Protection and Softer Touch

SpillSeal® Washable Corded Keyboard S6000K represents the ultimate in ergonomic design coupled with silver-based biocide for optimal antibacterial protection

Dallas, TX – March 23, 2008 — Unotron (www.unotron.com) , the international market leader and manufacturer of SpillSeal® technology, today introduced GermStopper™ SpillSeal® Washable Corded Keyboard S6000K: a sleek new computer keyboard design with antibacterial protection actually incorporated into the plastic for added safety and a new soft touch for easier typing. Renowned for manufacturing high quality, washable data input and security devices that are easily cleaned and disinfected to mitigate the spread of infection in hospital/healthcare settings, commercial and government environments, Unotron’s patented SpillSeal® protection allows keyboards to become fully submerged in water or antibacterial solutions for disinfecting.

“We have made SpillSeal® even more effective, with significant research and dedicated resources powering the introduction of this new technology which is not only exceptional for disinfecting keyboards and protecting them from accidental spills, but also offering users the utmost in antibacterial protection,” says Nancy Makoben, director of sales for Unotron. “Incorporated into the plastic of our new keyboards is an inorganic silver-based biocide which allows silver ions to counteract the molecular process of microorganisms -- more commonly known as bacteria. This causes the harmful organisms to die, lose their ability to infect, and prevent reproduction.”

A powerful, broad-spectrum, inorganic, silver-based biocide is integrated into the plastic of the SpillSeal® Washable Corded Keyboard S6000K. Silver ions are maintained in inorganic matrices to become antimicrobial with very low toxicity levels as well as being non-corrosive, non-flammable, and non-sensitizing.

The integration of silver-based biocides is widely used throughout Japan and is rapidly catching on in the U.S. and in Europe. Silver-based biocides are the future of bacteria-free environments because they can be incorporated into numerous products including but not limited to plastic.

“Antibacterial protection is not the only added feature to Unotron’s new S6000K keyboard,” says Makoben. “Quality and safety go hand in hand on the S6000K, offering the performance you expect with soft typing and a detachable wrist rest providing responsive keys and extra support and comfort when you need it.”

She notes that today’s fast-paced office and medical environments limit the ability to constantly disinfect equipment, adding, “Our new antibacterial keyboards offer more convenient cleanliness and the comfort of soft touch typing.”

About Unotron
With 30 years of OEM manufacturing experience, Unotron maintains a global footprint with offices located across North America, Europe and Asia, making everyday computing clean and safe for organizations around the world. Unotron designs, manufactures and markets high quality, washable data input and security devices that are easily cleaned and disinfected to mitigate the spread of infection in healthcare, education, commercial and government environments. Unotron holds patents for SpillSeal® technology and draws upon a catalogue of patents in automated manufacturing systems and office products. For more information, visit www.unotron.com or call 800.469.7440.

 

New Accreditation System Launched to Recognize Best Practice in Medical Tourism

TreatmentAbroad.com, the leading provider of information on overseas treatment options, has launched the first medical tourism code of practice for healthcare providers. The Code of Practice for Medical Tourism aims to encourage best practice in medical tourism through a commitment by healthcare providers overs to a voluntary code of practice. The Code will help inform the choices of the 100,000 UK patients, and medical tourists worldwide, who travel abroad for treatment every year.

The Code is an opportunity for providers to reassure patients considering overseas treatment that they are adopting best practice. It has been launched at a time when more people than ever are having treatment abroad and reporting highly positive experiences. A study published by Treatment Abroad reveals that 96 per cent of patients who have had overseas treatment would return to the same treatment provider.

Keith Pollard, Managing Director of Treatment Abroad, said: "These results are good news for providers and patients. There is no doubt that the medical tourism industry will continue to grow and to help patients make the right choice we have launched The Code of Practice for Medical Tourism.

"The Code will recognize and promote best practice within the international private healthcare arena and will provide reassurance to patients about the services on offer."

Healthcare providers who sign up to the Code will be identified as adopting a "best practice for medical tourism" and will be recognised on www.treatmentabroad.com - where 50,000 consumers who are considering overseas treatment look for information every month. In addition providers who are approved will be able to display the Treatment Abroad accreditation mark on their website and patients will be able to access accreditation details online.

Keith Pollard continues, "We have developed the Code in consultation with our clients and external specialists and I am confident that it will provide benefits for healthcare providers and patients. This is a positive step for the industry and offers a chance for providers to demonstrate their commitment to best practice in dealing with patients from overseas"

In order to receive accreditation, providers will be asked to demonstrate best practice in a number of areas covering provision of information, the patient experience and contractual terms, conditions and guarantees. The application is then approved by an independent consultant.

Keith Pollard concludes, "The research we have published shows that patients are incredibly happy with the standard of their treatment and the Code offers providers a way to formalize this."

The research undertaken by Treatment Abroad is the first to examine the motivations and experiences of UK residents who travel abroad for a range of medical treatment and is resoundingly positive.

It concludes that the top reason for people seeking treatment overseas, stated by 83 per cent, is to save money. Spending on treatments varies from less then £1,000 (approx 1,300 Euro) to over £10,000 (13,000 Euro). Nearly 10 per cent of patients estimated that they had saved as much as £10,000 by traveling abroad.

Patient satisfaction levels are high, and 97 per cent of patients said they would be willing to travel abroad for treatment again. In addition, 85 per cent of patients said they were fully satisfied with the standards of communication and follow-up received from the provider.

In addition to being motivated by cost savings, 56 per cent of elective surgery patients stated that they were worried about the risk of infections, such as MRSA, in the UK and that this had influenced their decision to travel abroad.

The research found that around 60 per cent of medical tourists were female and the majority is aged between 40-59 (56.5 per cent). The top destinations for treatment include Hungary, predominantly for dental treatment, Cyprus, for cosmetic surgery and India, for surgery and scans. Spain, Belgium and the Czech Republic are also among the most popular destinations.

Further information about the research is available at:
www.treatmentabroad.com/medical-tourism/medical-tourist-research

Further information about the Code of Practice for Medical Tourism is available at:
www.treatmentabroad.com/medical-tourism/code-of-practice

 

Update to HIPAA Issues

In the last issue of Medical Travel Today we featured a story by Purvi B. Maniar, Partner, Epstein, Becker Green P.C. entitled “HIPAA Considerations for Intermediaries in Medical Tourism.” Unfortunately, we did not receive the author’s final changes prior to publication date . Below, please find an updated version of her article which differs from the original.

HIPAA Considerations for Intermediaries in Medical Tourism
By Purvi B. Maniar, Partner, Epstein, Becker Green P.C.

Among the questions regarding legal matters often raised by organizations in the United States which are involved in facilitating travel abroad by U.S. patients for medical care are to what extent are they governed by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and what are their obligations under HIPAA with respect to patient privacy. This article is intended to examine the implications of HIPAA for “intermediaries” or “matchmakers,” in medical tourism, i.e. companies (in the United States) which facilitate overseas medical tourism in certain commonly used medical tourism arrangements.

By way of brief overview, HIPAA is a United States federal statute that includes various provisions intended to protect the privacy and security of personal health information of individuals. HIPAA privacy standards govern the use and disclosure of “protected health information” by “covered entities”. “Protected health information” (commonly referred to by its acronym “PHI”) generally refers to information created or received by a health care provider, health plan, employer, or health care clearinghouse which relates to the past, present or future physical or mental health or condition of or provision of health care to an individual or the past, present or future payment for the provision of healthcare to an individual, and that identifies (or provides the means to identify) the individual. “Covered Entities” are healthcare providers (e.g. physicians, hospitals), health plans (e.g., health insurance and managed care companies and employer sponsored benefit plans), and health care clearinghouses (e.g. WebMD, intermediaries between providers and payors which translate data into required formats). HIPAA security rules are applicable to covered entities which transmit, create or receive PHI in electronic form and these rules require reasonable physical, technical and administrative safeguards to protect the security of PHI. This article is intended to focus on the patient privacy implications of HIPAA, and therefore a full discussion of the application of the HIPAA security rules is beyond the scope of this article.

As a general matter, HIPAA does not directly require compliance by intermediaries that facilitate overseas medical tourism because these companies do not generally fall within the definition of “covered entities”. (However, as discussed below, these companies may be indirectly required to comply with the HIPAA privacy standards if they become “business associates” of covered entities.) Thus, in the scenario where an individual patient in the United States elects to travel abroad to receive medical care by arranging for such care either directly with an overseas hospital or through an intermediary that facilitates such travel, the intermediary arranging for the treatment would not be liable under HIPAA with respect to use or disclosure of medical information of the patient. Of course, the overseas hospital providing the care or the intermediary may still be held liable if violation of any applicable privacy laws of the local country where the treatment was provided were to occur. (It is also unclear whether the overseas hospital would have liability under HIPAA and the answer may depend on the level and type of involvement it has in seeking patients in the United States.) The intermediary or the overseas provider may also be held liable if they violate any agreement which they entered into with the patient, or any policy to which they have adopted that the patient relied upon, governing the use and disclosure of the medical information of the patient.

As medical tourism is becoming more widely accepted in the United States, an increasing number of health plans, e.g. managed care companies and employer sponsored benefit plans are becoming interested in offering medical tourism as an option to their enrollees in an effort to manage costs while providing quality medical care. For a medical tourism intermediary, contracting with such health plans to provide medical care to or facilitate medical tourism by their enrollees represents a significant opportunity to attract patients in volumes rather than on an individual basis. However, because a health plan in the United States is a covered entity, it is not, in many instances, allowed to disclose protected health information to third parties unless the third party enters into an agreement to become a “business associate” of the health plan. As a “business associate”, the intermediary is required to use appropriate safeguards to prevent use or disclosure of the PHI other than as provided for by its contract with the health plan, report to the health plan any use or disclosure of the information not provided for by its contract of which it becomes aware, and ensure that any subcontractor to whom it provides PHI agrees to the same restrictions and conditions that apply to the business associate with respect to such information. As a business associate, the intermediary will also be required to satisfy individual rights requirements as to access, amendment and accounting on behalf of the health plan, make internal practices, books, and records relating to the use and disclosure of PHI available to the Secretary of the U.S. Department of Health and Human Services and return or destroy all PHI at the termination of the agreement.

Covered entities may be subject to civil and criminal penalties as well as imprisonment for violations of HIPAA. The penalties may consist of fines of up to $50,000 and, if the offense is with intent to sell, transfer, or use individually identifiable health information for commercial advantage, personal gain or malicious harm, fines of up to up to $250,000. While HIPAA does not provide for direct liability of business associates to the government or to individual patients, the business associate agreement with the covered entity will often require the business associate to indemnify the covered entity for damage incurred by the covered entity arising out of violations by the business associate. Thus, the intermediary may be contractually liable to reimburse the health plan for penalties that the health plan may incur arising out of privacy violations by the intermediary.

For intermediaries in medical tourism, a successful, scaleable business model usually presumes contracts with managed care plans or self-insured employers who can refer a steady stream of patients who can take advantage of medical tourism. Such a relationship will inevitably require the intermediary to become a business associate of the health plan. To the extent that the intermediary can demonstrate that it is already compliant with applicable industry privacy and security standards by having effective policies, procedures and monitoring mechanisms in place, this will go a long way in reassuring the health plan that it is entering into a relationship with the right partner. Such measures could include retaining a designated HIPAA officer for implementation and oversight, which is not specifically required by HIPAA, but is one of the industry best practices.

As a final caveat, the intermediary should bear in mind that while HIPAA preempted all state privacy laws which were less stringent than HIPAA, to the extent a state’s privacy laws are more stringent, they remain in effect and are applicable in addition to the requirements of HIPAA. Therefore, whether or not the intermediary is a business associate of a covered entity under HIPAA, it should also verify whether any state laws would be applicable in the state in which it is located and in which the patients that it facilitates reside.

If you have any questions or comments about this article or on this topic, please feel free to contact Purvi B. Maniar by email at pmaniar@ebglaw.com.

This publication is provided for general information purposes; it is not and should not be used as a substitute for legal advice.

---

DESTINATION

Monterrey, Mexico

Not a medical tourism destination that's attracted a lot of attention...yet. But that could change now that Mexico's third-largest city, located just 150 miles south of the U.S. border, has two JCI-accredited hospitals, with possibly a third by summer.

By Robin Elsham

Monterrey , Mexico 's appeal as a service destination is a lot like the appeal of medical travel itself. At first mention, people are surprised to hear something they've never considered being described so positively. But once they begin researching the topic, they're stunned by the dimension of the appeal.

With medical tourism, the appeal begins with cost savings—but soon expands to encompass other compelling factors. Access to more personalized care, even access to superior medical care.

With Monterrey, its appeal as a service destination only begins with its geographical advantages. Or the fact that it's home to the only two hospitals in Mexico so far with JCI accreditation. The more you know about Monterrey, the more compelling it becomes across the entire spectrum of criteria used for selecting a medical travel destination.

Along with other Mexico border destinations like Tijuana, it's the nearest, fastest, cheapest international treatment destination for Americans and Canadians. Monterrey is just a one-to-two hour plane trip from southern U.S. cities, and served by direct flights from eight: Los Angeles, Las Vegas, Chicago, San Antonio, Dallas, Houston, Atlanta and Miami. In all there are 40 flights daily to Monterrey from the U.S. To get from General Mariano Escobedo International Airport into the city by taxi costs about $20 and takes just a half hour.

Monterrey also contains the largest concentration of first-rate, world-class medical facilities in northern Mexico, a byproduct of the city's size and affluence. With a metro-wide population of just under four million people, Monterrey is Mexico's third-largest city (after Mexico City and Guadalajara) and twice the size of Tijuana.

By other measures—some of even greater importance to medical tourists— Monterrey ranks first. It's Mexico's wealthiest city, and also its safest. In recent years, there has been an increase in drug-related violence, a byproduct of the city's affluence. Some drug lords apparently moved to Monterrey because it was easier to blend in there if you drove a BMW or Porsche.

There are lots of Beamers and Boxsters on the roads in Monterrey because so many major companies are headquartered there. The list includes Cemex, the world's third-largest cement maker, FEMSA (or Coca-Cola Latin America), Alfa (petrochemicals, food, telecommunications and auto parts), and Cerveceria Cuauhtemoc Moctezuma, the brewer of Tecate, Dos Equis, Carta Blanca and other brands of beer.

Monterrey is the capital of the northern Mexican state of Nuevo Leon, thus a center for government activities. It's also home to four internationally significant universities: Universidad Autonoma de Nuevo Leon (UANL), the third-largest university in Mexico; Instituto Tecnologio y de Estudio Superiores de Monterrey (more commonly known as Tec de Monterrey), widely considered to be the top university in Mexico, either public or private; University of Monterrey; and Universidad Regiomontana.

A large hospital system and a highly developed medical services industry exists to provide healthcare services to this large, wealthy city, providing the perfect industry eco-system for the area to become a medical tourism hub. With few exceptions, the areas around the world which have emerged as leading service destinations are places with robust local economies. Private hospitals developed in these areas primarily to cater to the medical needs of fast-growing middle and upper classes with money to pay for first-class healthcare. Those conditions all exist in spades in Monterrey.

Altogether there are 10 hospitals or hospital groups in Monterrey already targeting medical tourism, or considering doing so, according to Maricela Gomez Seeman, director of tourism product development at the Nuevo Leon Department of Tourism. Two of the three hospitals already attracting medical travelers have American hospital groups as partners.

Christus Muguerza, the combination formed by the 2001 union between Monterrey-based Muguerza hospitals and Dallas-based Christus Health, which operates 40 hospitals and other heathcare facilities in more than 70 U.S. cities, operates the first JCI-accredited hospital in Monterrey. Its High-Specialty Hospital is currently accredited through July 21, 2010. The 188-bed facility currently has a small, nine-bed international ward, where patients are ministered to by English-speaking doctors and nurses.

Christus Muguerza has invested more than $100 million over the past four years gearing up to attract and treat international patients, who totaled 60 last year, a number forecast to quintuple this year, according to Jaime Alonso of the hospital's medical travel unit. Christus Muguerza, which currently owns five hospitals in Mexico, planned to open a sixth (a 50-bed level-two facility) in March in Reynosa, on the Nuevo Leon-Texas border. Over the next 10 years, Christus Muguerza plans to increase its network to 20 hospitals, with up to half being JCI accredited, according to Alonso.

Hospital San Jose, which is affiliated with Tec de Monterrey, received notification last month that it had qualified for JCI accreditation. Some 2,000 physicians are involved in treating patients at Hospital San Jose, which has 11 operating rooms and is affiliated with Methodist Hospital and Baylor University's College of Medicine in Houston. San Jose was chosen by the U.S. Embassy to care for President George Bush, and by the Spanish Embassy to treat President Jose Aznar, should either leader have required hospital care while in Monterrey for an international conference in 2002.

The 50-bed CIMA Santa Engracia Hospital expects to receive JCI accreditation by mid-year, according to its medical director, Dr. Horacio Decanini Arcaute. The hospital provided care to 200 international patients last year, with most there for gastric bypass surgery (17%), plastic surgery (20%), or joint replacement surgeries (20 patients), according to Dr. Decanini.

The hospital, part of the CIMA (Consorcio Internacional Hospital, S.A.) group affiliated with Dallas-based International Hospital Corp. and Baylor University Medical Center in Dallas, has plans to add a cath lab by year-end. Currently, cardiac patients are referred to the CIMA hospital in Hermosillo, Mexico.

The appeal of Monterrey then is based on: convenience of location; presence of a highly developed local medical industry, including two (and maybe soon three) JCI-accredited hospitals; presence of large numbers of English-speaking physicans, many of whom trained or previously worked in the United States and are U.S.-board certified in their specialties; and an extremely appealing natural appeal. Monterrey is ringed on three sides by mountains, which provide a picturesque backdrop to a central city filled with some of the loveliest public spaces in North America.

Cost is the one decision-making variable on which Monterrey scores poorly. It's at the high-end globally. " Mexico is on average 40 percent cheaper for basic surgical procedures," the Dallas News reported in mid-2007, citing David Warner, a health researcher at the LBJ School of Public Affairs at the University of Texas in Austin.

It's also toward the higher end in terms of accommodation costs, a status owed in no small part to the 17% tax slapped on every room bill (15% state tax, and 2% city hotel tax).

Nevertheless, a full and sophisticated analysis of all site selection criteria would likely make Monterrey a top choice for many procedures, and in particular: 1) less costly treatments, where travel costs account for up to a third of the entire medical travel bill; 2) procedures requiring more than one visit; 3) treatment of a patient who for whatever reason needs to travel as little as possible; and, 4) a service site for U.S. group healthcare providers, whose selection criteria weighs factors affected by travel distance heavily enough to compensate for Monterrey's relatively high medical costs.

Robin Elsham is the managing director of Patients With Passports Corp., an international healthcare arranger based in St. Paul, Minnesota. He can be contacted at robin.elsham@patientswithpassports.com